# Passive euthanasia and living wills in India **TL;DR:** Indian law permits passive euthanasia, that is, the withdrawal or withholding of life-sustaining medical treatment to allow a natural death, under a framework built by three Supreme Court decisions: Aruna Shanbaug (2011), Common Cause (2018), and Harish Rana (2026 INSC 222). Any adult of sound mind can execute a living will (advance medical directive) before a notary or gazetted officer. In 2026, the Supreme Court for the first time actually applied the 2018 guidelines to permit withdrawal of nutrition and hydration from a patient in a permanent vegetative state, confirming that clinically assisted nutrition delivered through a PEG tube is medical treatment, not basic care. --- ## On this page - [The three landmark judgments](#the-three-landmark-judgments) - [Active versus passive euthanasia: the legal line](#active-versus-passive-euthanasia-the-legal-line) - [The living will: how to make one today](#the-living-will-how-to-make-one-today) - [The medical board procedure](#the-medical-board-procedure) - [Harish Rana (2026 INSC 222): the first judicially permitted case](#harish-rana-2026-insc-222-the-first-judicially-permitted-case) - [What the Harish Rana decision changed](#what-the-harish-rana-decision-changed) - [Limits of the law](#limits-of-the-law) - [How Niyam helps](#how-niyam-helps) - [Frequently asked questions](#frequently-asked-questions) - [Key takeaways](#key-takeaways) --- ## The three landmark judgments Indian law on passive euthanasia has been built case by case over fifteen years. Three Supreme Court decisions form the architecture. ### Aruna Ramchandra Shanbaug v Union of India, (2011) 4 SCC 454 Aruna Shanbaug was a nurse at KEM Hospital, Mumbai, who was assaulted in 1973 and left in a permanent vegetative state for over three decades. A journalist, Pinki Virani, filed a writ petition before the Supreme Court seeking permission to withdraw her nutritional support. The two-judge bench of Justices Markandey Katju and Gyan Sudha Misra, deciding in March 2011, refused the specific prayer (the hospital staff who had cared for Aruna opposed withdrawal) but laid down guidelines permitting passive euthanasia subject to High Court approval. The bench held that the right to life under Article 21 of the Constitution includes the right to die with dignity. It permitted withdrawal of life-sustaining treatment for patients in a permanent vegetative state, but required that any such decision be approved by the High Court having jurisdiction, acting on the opinion of a medical board of three reputable doctors nominated by the court. This made the procedure judicially supervised and, in practice, cumbersome. The Shanbaug framework was deliberately interim. The court acknowledged that the matter touched legislation and invited Parliament to act. Parliament did not. The Supreme Court revisited the issue in 2018 through a Constitution Bench. ### Common Cause (A Regd. Society) v Union of India, (2018) 5 SCC 1 A five-judge Constitution Bench, comprising Chief Justice Dipak Misra and Justices A.K. Sikri, A.M. Khanwilkar, D.Y. Chandrachud, and Ashok Bhushan, delivered judgment on 9 March 2018. The unanimous holding was that the right to die with dignity is an intrinsic facet of the right to live with dignity guaranteed under Article 21. The court made four important moves. **First**, it overruled the requirement of High Court approval for every case of withdrawal of life support. That requirement had made Shanbaug's framework impractical. **Second**, it recognised the concept of an advance medical directive (AMD), commonly called a living will. A competent adult could prospectively authorise withdrawal of treatment in specified terminal or vegetative conditions, removing the need for court intervention in every case. **Third**, the court replaced the High Court approval route with a two-tier medical board mechanism at the hospital and district level, with an option to approach the High Court only if the boards disagreed or if the family was dissatisfied. **Fourth**, the judgment set out detailed procedural safeguards for both the execution of an AMD and the process of withdrawing treatment where no AMD exists. The 2018 guidelines were exhaustive but, as practitioners quickly found, impractical. They required the AMD to be countersigned by a Judicial Magistrate First Class (JMFC). Medical board members needed twenty years of experience. The District Collector had a supervisory role. These requirements created bottlenecks that prevented the framework from being used. ### The 2023 Constitution Bench modification order In January 2023, a five-judge Constitution Bench led by Justice K.M. Joseph, with Justices Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy, and C.T. Ravikumar, took up a miscellaneous application filed by the Indian Council for Critical Care Medicine. The Council pointed out that the 2018 guidelines were unworkable in practice. The bench passed an order on 24 January 2023 making the following specific changes: - The requirement of countersignature by a JMFC was removed. An AMD may now be executed before a notary or a gazetted officer, with two attesting witnesses present. - The twenty-year experience threshold for medical board members was reduced to five years. - The District Collector's direct supervisory authority was substantially removed. Board constitution and process shifted to the hospital and to a secondary board nominated by the Chief Medical Officer. - Both the Primary Medical Board and the Secondary Medical Board are now expected to complete their evaluations "preferably within 48 hours," replacing the open-ended timelines of the original. - The JMFC's role in preserving copies of the AMD and personally visiting patients was eliminated. Custodian responsibilities were assigned to the competent officer of the local government or Municipality or Panchayat. - The executor of an AMD may now incorporate it into their digital health record. These changes materially simplified the procedure. The 2023 order is the current governing text alongside the 2018 judgment. --- ## Active versus passive euthanasia: the legal line The distinction between active and passive euthanasia is not merely semantic in Indian law. Active euthanasia remains illegal and, depending on the facts, would attract liability under the Bharatiya Nyaya Sanhita, 2023 (which replaced the Indian Penal Code, 1860). Passive euthanasia is conditionally lawful. | Feature | Passive euthanasia | Active euthanasia | |---|---|---| | Definition | Withholding or withdrawing life-sustaining treatment | Deliberate act (e.g., lethal injection) to cause death | | Legal status in India | Conditionally lawful (Common Cause, 2018; Harish Rana, 2026) | ✗ Illegal | | Requires court approval | ✗ Not always (AMD avoids it; medical boards can approve) | Not applicable | | Requires medical board | ✓ Yes, for withdrawal decisions | Not applicable | | Requires AMD | ✗ Not always (boards can act in patient's best interest) | Not applicable | | Patient must be terminal/PVS | ✓ Yes | Not applicable | | Physician liability | ✓ Protected if procedure followed | ✗ Criminal exposure | | Initiative | Omission: stopping treatment that sustains life | Commission: positive act causing death | The courts have been careful to hold the line. In Harish Rana (2026 INSC 222), the bench of Justices J.B. Pardiwala and K.V. Viswanathan reaffirmed that passive euthanasia "involves withholding or withdrawing of life-sustaining medical treatment, allowing natural death to occur," while active euthanasia uses a "deliberate act such as a lethal injection" and is explicitly outside the permissible zone. The legal rationale for the distinction draws on the difference between omission and commission and, ultimately, on the principle that a patient's Article 21 right to die with dignity should not require the patient to endure medically futile treatment. --- ## The living will: how to make one today An advance medical directive (AMD), or living will, is a document by which a mentally competent adult directs, in advance, that certain medical treatments be withheld or withdrawn in specified future conditions. The current requirements flow from the 2018 judgment as modified by the 2023 order. ### Who can make one Any person who is an adult and of sound mind. There is no prescribed form, but the document must be in writing. ### What the AMD must contain - A clear statement of the medical conditions in which treatment is to be withheld or withdrawn (for example, permanent vegetative state, terminal illness with no prospect of recovery). - The specific treatments covered, such as mechanical ventilation, cardiopulmonary resuscitation, or clinically assisted nutrition and hydration. - The name of a guardian or close relative authorised to give effect to the directive. - A statement that the document is made voluntarily and without coercion. ### Execution The AMD must be: 1. Signed by the executor in the presence of two attesting witnesses. The court prefers independent witnesses. 2. Countersigned by a notary public or a gazetted officer. (The pre-2023 requirement of a JMFC countersignature no longer applies.) ### Registration and custody The executor should forward a copy to the competent officer of the local government or Municipality or Panchayat, who will arrange for a custodian. The AMD may also be incorporated into the executor's digital health record. ### Revocation An AMD can be revoked at any time while the executor retains mental capacity. ### What happens when the condition arises If the patient's condition matches the AMD, the attending physician constitutes a Primary Medical Board (see below). If the board concurs that the condition meets the AMD criteria, the withdrawal process proceeds. The family is informed at each stage and may approach the High Court if dissatisfied. --- ## The medical board procedure Where a patient does not have an AMD but is in a terminal or vegetative state, or where the AMD is contested, the decision to withdraw treatment must go through a two-tier board process. ### Primary Medical Board Constituted at the hospital where the patient is admitted. Under the 2023-modified procedure, the board comprises: - The treating physician. - At least two subject-matter specialists, each with a minimum of five years of post-qualification experience in the relevant specialty. The board examines the patient, reviews all medical records, and forms an opinion on whether continued treatment is futile and whether withdrawal is in the patient's best interest. It must record reasons. The court's expectation is that this assessment be completed within 48 hours where possible. ### Secondary Medical Board If the Primary Board supports withdrawal, a Secondary Medical Board is constituted. Its members are nominated by the Chief Medical Officer of the district. The Secondary Board independently reviews the Primary Board's findings. Again, the 48-hour target applies. ### Informing the family The hospital must inform the family at both board stages. The family's consent, while not an absolute veto, is a material factor in the best-interest analysis. ### High Court route If either board refuses withdrawal, or if the family or medical team disagrees, any party may move the High Court. The High Court may constitute its own medical committee. This route was available under Shanbaug (2011) as the primary pathway; under the 2018 framework it is a residual safeguard. For petitions raising constitutional questions about the framework itself, the Supreme Court remains the appropriate forum. --- ## Harish Rana (2026 INSC 222): the first judicially permitted case ### Background Harish Rana was 20 years old and a B.Tech student in Chandigarh when, in August 2013, he fell from the fourth floor of his accommodation. He sustained a diffuse axonal brain injury, resulting in permanent vegetative state and complete quadriplegia. For thirteen years he remained bedridden, sustained by a tracheostomy and Clinically Assisted Nutrition and Hydration (CANH) delivered through a Percutaneous Endoscopic Gastrostomy (PEG) tube surgically inserted into his stomach. Medical boards confirmed irreversible, non-progressive brain damage with no prospect of recovery. He had no environmental awareness and could not express hunger or discomfort through any gesture. CANH through a PEG tube is distinct from a Ryle's tube (a nasogastric tube inserted through the nose): a PEG tube requires a surgical procedure and delivers nutrition directly into the stomach. The distinction matters because PEG tube feeding is more clearly a clinical intervention rather than ordinary assisted feeding. ### What the parents sought Harish Rana's elderly parents sought permission to withdraw the PEG tube, arguing that continued CANH merely prolonged biological existence without any therapeutic benefit, and that doing so constituted medical treatment capable of withdrawal rather than basic care that must continue regardless of prognosis. ### The Delhi High Court's 2024 refusal The Delhi High Court dismissed the family's petition in 2024. The court reasoned that withdrawal of CANH would result in the patient dying from the absence of nutrition and hydration, which it characterised as starvation rather than natural death consequent on cessation of medical treatment. The court also drew a distinction between patients sustained by mechanical ventilation (where withdrawal clearly removes artificial life support) and patients sustained only by nutritional support. It treated CANH as closer to basic care than to a medical intervention in the full sense. The family appealed to the Supreme Court. ### The Supreme Court's decision, 11 March 2026 A bench of Justices J.B. Pardiwala and K.V. Viswanathan allowed the appeal and permitted passive euthanasia by approving withdrawal of CANH. The judgment is reported as Harish Rana v Union of India, 2026 INSC 222. The court's reasoning rested on four pillars. **CANH is medical treatment.** The bench held squarely that clinically assisted nutrition and hydration delivered through a PEG tube constitutes medical treatment, not basic care. The reasoning was that CANH "requires periodic review, medical evaluation and clinical judgement" and is qualitatively different from ordinary assisted feeding. Once CANH is classified as medical treatment, the entire passive euthanasia framework under Common Cause applies to it. This directly reversed the Delhi High Court's implicit categorisation. **The best-interest standard.** For a patient who lacks decision-making capacity, the court applied a best-interest analysis. It held that the best-interest principle "does not have a straight-jacket formula" but requires assessing medical and non-medical factors including "the patient's wishes, feelings, beliefs, values." The court found that continued CANH served no therapeutic purpose and that its continuation was not in Harish Rana's best interest. **Substituted judgment.** Alongside best interest, the bench applied a substituted judgment inquiry: what would this patient have chosen had he retained capacity? The court noted Harish Rana's pre-injury engagement in sports and physical fitness and reasoned that he would not have wished to be maintained in an irreversible vegetative state with no prospect of recovery. **Palliative care, not abandonment.** The court was careful to hold that withdrawal of treatment does not mean abandonment of the patient. It directed a step-by-step withdrawal of CANH through a clearly articulated and medically supervised palliative and end-of-life care plan, with AIIMS directed to provide palliative care. The court also waived the standard 30-day reconsideration period that the 2018 guidelines contemplated, to prevent unnecessary prolongation of suffering given the clarity of the clinical picture. The Union of India, appearing as a respondent, agreed to provide palliative care. Justice Pardiwala addressed the parents directly in the judgment: "You are allowing him to leave with dignity. It reflects the depth of your selfless love and devotion towards him." This was the first time, since Common Cause was decided in 2018, that the Supreme Court actually applied the passive euthanasia framework to an individual case and permitted treatment withdrawal. All prior cases had established the framework in the abstract; Harish Rana applied it in practice. --- ## What the Harish Rana decision changed The 2026 judgment settled several questions that remained open after Common Cause. **CANH as medical treatment.** The most significant doctrinal contribution is the clear holding that clinically assisted nutrition and hydration, regardless of the delivery mechanism (PEG tube, nasogastric tube, or otherwise), is medical treatment subject to the passive euthanasia framework. Hospitals and medical boards now have clear authority, and clear obligation, to evaluate CANH withdrawal requests under the Common Cause boards procedure. **Best interest plus substituted judgment.** The judgment grafts the substituted judgment enquiry alongside the best-interest standard. Medical boards should now consider both what is objectively in the patient's interest and what the patient's own values and history suggest about their preference. **Waiver of the 30-day reconsideration window.** The 2018 guidelines contemplated a period for reflection after the medical boards gave their opinion. Harish Rana confirms that courts can waive this where the medical picture is unambiguous and waiting serves no purpose other than to extend suffering. **Palliative care as mandatory, not optional.** The court's direction to AIIMS to provide palliative care, and the Union's agreement, establishes that withdrawal of life-sustaining treatment must be accompanied by active palliative and comfort care. Withdrawal is not a licence to abandon. **High Court gatekeeping reduced further.** Under Shanbaug, the High Court had to approve every case. Under Common Cause, High Court involvement was residual. Harish Rana shows the Supreme Court itself acting on a direct petition without routing through a High Court medical committee, confirming flexibility in the procedural pathway for cases of legal novelty or urgency. For a deeper understanding of how to read and work with judgments of this kind, the guide on [how to read and brief an Indian judgment](/blog/how-to-read-a-judgment) covers the anatomy of a Supreme Court judgment including ratio, obiter, and concurring opinions. --- ## Limits of the law The framework, as it stands after Harish Rana, has clear boundaries. **Active euthanasia remains prohibited.** Any deliberate act designed to cause death, including administering a lethal substance, falls outside the permitted zone. Physicians who go beyond withdrawal of treatment into an affirmative act of causing death face criminal liability. **No right to physician-assisted suicide.** The framework addresses patients in terminal illness or permanent vegetative states. It does not create a right for a competent but suffering patient to request assistance in dying actively. This is a different legal question that the courts have not addressed. **AMD must anticipate the condition.** A living will is only effective if the patient's present condition matches the conditions specified in the directive. A directive drafted in overly broad or overly narrow terms may not map cleanly onto the clinical reality. **Family consent matters but is not a veto.** The process requires the family to be informed and consulted at each board stage. However, the courts have been clear that the family's refusal to consent does not automatically block withdrawal where the medical boards have found continuation to be against the patient's best interest. Conversely, the family's desire for withdrawal must still pass through the board process; family desire alone does not authorise it. **Competency and coercion.** An AMD executed under coercion, or by a person who did not have capacity at the time of execution, can be challenged. The notary or gazetted officer and the two witnesses serve partly as a safeguard against this. **No legislation yet.** Despite the courts' repeated invitations since 2011, Parliament has not enacted an end-of-life care statute. The framework rests entirely on judge-made law. This creates some uncertainty at the margins: hospitals outside major cities may be unfamiliar with the procedure, and the 48-hour targets for boards are aspirational rather than enforceable in the way a statutory timeline would be. For practitioners working on writ petitions touching end-of-life care, the jurisdiction and procedure of the High Court under Article 226 is explained in [the guide to writ jurisdiction under Article 226](/blog/high-courts-article-226). Niyam's research engine covers 72,000+ Indian judgments including every reported Supreme Court and High Court decision on Article 21, and can surface the precise passages from Common Cause and Harish Rana relevant to a given clinical or legal question. You can also ask Niyam to draft an AMD tailored to a client's instructions and verify it against the current procedure. [Start for ₹100](https://app.niyam.ai/register) and research passive euthanasia case law, draft advance medical directives, or check the current board procedure with cited primary sources. --- ## Frequently asked questions ### What is passive euthanasia and is it legal in India? Passive euthanasia means withholding or withdrawing life-sustaining medical treatment so that the patient's natural death is not artificially delayed. It is conditionally legal in India following Common Cause v Union of India, (2018) 5 SCC 1, as modified by the 2023 Constitution Bench order and applied in Harish Rana v Union of India, 2026 INSC 222. The conditions are a permanent vegetative state or terminal illness with no prospect of recovery, a two-tier medical board opinion, and compliance with the prescribed procedure. ### What is active euthanasia and why is it illegal in India? Active euthanasia involves a deliberate affirmative act, such as administering a lethal drug, to cause a patient's death. It is illegal in India. The Supreme Court has consistently held that the passive-active distinction is constitutionally significant: passive euthanasia involves an omission (stopping treatment), while active euthanasia involves a commission (a positive act causing death). A physician who performs active euthanasia would face criminal liability. ### What is a living will or advance medical directive in India? A living will, formally called an advance medical directive (AMD) in the Common Cause framework, is a written document by which a mentally competent adult specifies in advance the conditions under which life-sustaining treatment should be withheld or withdrawn. It becomes operative when the person no longer has capacity to communicate their wishes. The document must be signed before two attesting witnesses and countersigned by a notary or gazetted officer. ### Who can make a living will in India? Any adult of sound mind. There is no prescribed form, but the document must be in writing, must clearly describe the clinical conditions in which it should operate, must name a guardian or family member to act on it, and must be executed in the presence of two attesting witnesses and attested by a notary public or a gazetted officer. ### Do I still need a magistrate to sign my living will? No. The 2023 Constitution Bench order removed the requirement of countersignature by a Judicial Magistrate First Class (JMFC). A notary public or a gazetted officer now suffices. This was one of the central simplifications made in January 2023. ### What conditions must exist before a living will can be acted on? The patient must be in a condition matching the description in the AMD, typically permanent vegetative state or terminal illness with no prospect of recovery. The attending physician must constitute a Primary Medical Board, which verifies the clinical facts. If the board's opinion supports withdrawal and a Secondary Medical Board concurs, the AMD can be given effect. The family must be informed throughout. ### What is a Primary Medical Board and who sits on it? The Primary Medical Board is constituted at the hospital where the patient is admitted. Under the 2023-modified procedure, it consists of the treating physician and at least two subject-matter specialists, each with a minimum of five years of relevant post-qualification experience. (The earlier requirement of twenty years of experience and a board of four doctors was relaxed in January 2023.) ### What is a Secondary Medical Board? The Secondary Medical Board is an independent body whose members are nominated by the Chief Medical Officer of the district. It reviews the Primary Board's findings independently. Under the 2023 modifications, the earlier requirement of District Collector involvement in convening or overseeing this board was substantially removed. Both boards are expected to complete their evaluations within 48 hours where possible. ### What happens if the medical boards disagree, or the family objects? Either the treating team or the family may move the competent High Court. The High Court may constitute its own medical committee and pass appropriate orders. This judicial route was the primary pathway under the 2011 Shanbaug framework; it is now a residual safeguard. ### What was the Harish Rana case about? Harish Rana was a 32-year-old man who had been in a permanent vegetative state since 2013 after falling from a building. He was sustained by clinically assisted nutrition and hydration (CANH) through a PEG tube. His parents sought permission to withdraw the PEG tube. The Delhi High Court refused in 2024, treating CANH as basic care rather than medical treatment. The Supreme Court overturned that in 2026 (2026 INSC 222), holding CANH to be medical treatment and permitting withdrawal. ### Why did the Delhi High Court refuse passive euthanasia in the Harish Rana case? The Delhi High Court in 2024 held that withdrawing clinically assisted nutrition and hydration would result in the patient dying from lack of nutrition, which it characterised as starvation rather than the natural death that follows cessation of medical treatment. It also drew a distinction between patients dependent on mechanical ventilation (clearly artificial life support) and patients sustained only by nutritional support, treating the latter as basic care. ### How did the Supreme Court answer the Delhi High Court's reasoning? The Supreme Court held directly that CANH delivered through a PEG tube is medical treatment, not basic care. The court's reasoning was that PEG-tube nutrition requires surgical insertion, medical monitoring, periodic clinical evaluation, and ongoing medical judgement. Because it is medical treatment, it is subject to the same ethical and clinical principles that govern other life-sustaining interventions, and it can be withdrawn where continuation is not in the patient's best interest. ### What is the "best interest" standard in end-of-life decisions? Where a patient cannot express their own wishes, the decision-maker, whether the medical board or the court, must assess what is in the patient's best interest. Harish Rana clarified that this does not follow a fixed formula. It requires weighing medical factors (diagnosis, prognosis, therapeutic benefit of continued treatment) and non-medical factors (the patient's personal values, prior expressed wishes, quality of life, and dignity). The standard is patient-centred, not purely clinical. ### What is the "substituted judgment" standard? The substituted judgment enquiry asks: if this patient retained decision-making capacity, what would they choose? It is applied alongside the best-interest standard in cases of permanent incapacity. In Harish Rana, the court considered the patient's pre-injury values and lifestyle, noting his engagement in sports and physical activity, to infer that he would not have chosen to be sustained indefinitely in a vegetative state. ### Does the family's consent determine the outcome? The family's position is a significant factor in the best-interest analysis, and the hospital must inform and consult the family at every board stage. However, family consent is not an absolute veto. Where the medical boards and, if necessary, the court are satisfied that withdrawal is in the patient's best interest, a family member's refusal to consent does not permanently block the process. Conversely, family desire for withdrawal must still pass through the board mechanism. ### Can a patient revoke a living will? Yes. An AMD can be revoked at any time while the executor retains mental capacity. The revocation should be in writing and communicated to the custodian (the local government officer or municipality) and to the executor's treating physician. ### Is palliative care mandatory when life support is withdrawn? After Harish Rana, the answer is clearly yes. The Supreme Court directed a "clearly articulated and medically supervised palliative and end-of-life care plan" and ordered AIIMS to admit Harish Rana into palliative care on withdrawal. The court treated continued comfort care as the correlate of withdrawal: patients are not to be abandoned; they are to be kept comfortable. ### Does passive euthanasia apply only to patients on mechanical ventilators? No, and this is the important doctrinal clarification in Harish Rana. The Delhi High Court had suggested a distinction between ventilator-dependent patients and patients sustained by nutritional support. The Supreme Court rejected that distinction. CANH through a PEG tube is medical treatment regardless of whether the patient is also on a ventilator. The relevant test is whether the treatment is life-sustaining and clinically managed, not whether it involves a breathing machine. ### Where can I find the actual text of these judgments? The Supreme Court's official repository at sci.gov.in carries the full texts of Common Cause (2018), the 2023 modification order, and Harish Rana (2026 INSC 222). Neutral citations (for example, 2026 INSC 222) allow direct lookup on the Supreme Court's judgment portal. For a guide to locating and citing Supreme Court judgments by neutral citation, see [the article on ESCR neutral citations and free judgment access](/blog/e-scr-neutral-citations). ### What should an advocate do if a client or hospital asks for help with a passive euthanasia application? The first step is to verify whether the patient's clinical condition meets the threshold (permanent vegetative state or terminal illness with irreversible prognosis). If an AMD exists, verify its execution against the post-2023 procedure. If no AMD exists, the hospital's treating physician must convene the Primary Medical Board. If the case raises novel legal questions or board disagreement, a writ petition to the High Court under Article 226 is the appropriate route. Advocates should read both the 2018 judgment and the January 2023 order carefully, as both remain operative. The [guide to reading and briefing an Indian judgment](/blog/how-to-read-a-judgment) is a practical reference for working through these lengthy constitutional decisions. --- ## Key takeaways - Passive euthanasia, the withdrawal or withholding of life-sustaining treatment, is conditionally lawful in India under Common Cause v Union of India, (2018) 5 SCC 1, as clarified by the January 2023 Constitution Bench order and applied in Harish Rana v Union of India, 2026 INSC 222. - Active euthanasia remains illegal. - Any competent adult can make a living will (advance medical directive). Since January 2023, it need only be attested before a notary or gazetted officer with two witnesses. Magistrate countersignature is no longer required. - Medical board members now need only five years of experience, down from twenty years under the original 2018 guidelines. - CANH (clinically assisted nutrition and hydration) through a PEG tube is medical treatment, not basic care, and can be withdrawn under the passive euthanasia framework: this is the key holding of Harish Rana (2026 INSC 222). - The best-interest standard and the substituted judgment enquiry both apply when evaluating withdrawal for an incompetent patient. - Withdrawal must be accompanied by palliative care. The court in Harish Rana directed an end-of-life care plan and AIIMS palliative admission as non-negotiable conditions of the permission. - Parliament has not legislated on end-of-life care despite repeated judicial invitations since 2011. The framework rests entirely on judge-made law, which creates some uncertainty at the institutional level, particularly in smaller hospitals. - Advocates advising hospitals or families should work from both the 2018 judgment and the 2023 modification order, not the 2018 text alone. [Start for ₹100](https://app.niyam.ai/register) to research passive euthanasia law, locate the Harish Rana judgment, or draft an advance medical directive grounded in the current Supreme Court procedure.